approaching a 2014 equal with the board approve and take back to kaiser, take it or leave it. >> thank you very much. next speaker, bobby, you are here already. we do have rebecca king and emma and joe bear, and thomas and ed and suzanna blang. >> hi. my name is brenda and i'm a city employee. i'm here because i'm the angry employee, i'm representing the angry employee because we keep making concession after concession and we see the city an allowing others to take take take and you don't stop it. i think this

is the time where we have paid more money than kaiser has to take care of the people of kaiser. we are the people who belong to kaiser. the otherwise don't. we don't want to pay for kaiser's increase. i don't think the city should pay. i think they have gotten enough. $800 million is more than enough. i think that you guys are standing strong. i was at another meeting where they were standing strong and it didn't happen. i'm hoping the board of supervisors will stand strong for the working people of san francisco and stand strong for even the citizens of san francisco because kaiser is not the only gouger to the city. so you have to start somewhere. so i'm saying start with kaiser.

>> thank you very much. next speaker, please. >> good afternoon supervisor mar and avalos. i have been working in mental health for the last 15 years. one of the things i want to stress today is accountability. what it seems to me is you know, these billion dollar corporations continue to bill the hardworking people of america that are just scraping by and they don't want to have any accountability for raising their rates. that's just unacceptable. you got to wonder why they are not doing that. it's pretty shady, don't you think. so what i'm here to testify is to block this increase and stand strong

against this corporation because what happens time and again with these super billion dollar entities. people fold, people get scared, people freak and run away. we can't do that. so you are talking about people's lives here. you are talking about already folks that are hardworking that aren't getting the raises they deserve, having to put out more money? it's not okay. please supervisors stand strong with this. we are here. we ain't going anywhere. thank you. >> next speaker. >> good afternoon, supervisors, my name is rebecca king, i'm the public health nurse with the city and county. i have been a kaiser member for 50 years. i very disappointed with kaiser at this time. when henry kaiser made an agreement to

take care of workers, they knew what they were doing and they valid them. kaiser's lack of transparency is disgusting right now. the fact that you call it an integrated care management bill, and that it's not a necessary physician's visit. this is not right. i'm very suspicious of kaiser's add campaigns and i'm a member and a taxpayer. how much do we have to pay for this ad. board members, stand strong. kaiser knows how to sit down at a table. stand strong. meet with them. make them accountable. don't sign a blank check to them. >> good afternoon. my name is

ed. i worked for the health department. as a retiree and taxpayer here in san francisco i want to say that i think it's scandalous that kaiser would come to this city and expect this rate increase to be approved without justification. it would be scandalous for the city to approve that rate without more information. as you know, the health service board rejected the rate increase back in may. they did the right thing. the health service board was covering a commercial health plan for expansion and profit to put some facts on the table to support this demand. as a purchasing agent, the health services board had every reason to say no to the proposals that were not complete, not persuasive and disrespectful of

the health evaluations board for cost and services that we buy and receive. those have not changed. only health plan would prefor multilocal government that would refuse to support it. as a taxpayer and retiree, i ask you don't let them get away with it. rejection is still the right thing to do. bring kaiser back to a serious table to renegotiate realistic rates. thank you. >> thank you supervisors. chris bailey. aclu. kaiser is the outlier. they were asked to justify their rate increase, despite declining utilization

rates. kaiser's response, "we consider the detail response and analysis to be proprietary." in other words we are not giving you a justification for these rates. i railed against multimillion dollar packages. in this case, our neighbor up in salas salas -- lito, the lack of information. $15 million of the people of the city and county of san francisco's money an additional profit for kaiser, unjustified. the man is earned

his $8 million. this city works day and night to find in the budget and you move $125 million to fund the community services that were left unfunded. today you are discussing this $15 million that is 60 percent of this committee's work over a month. aclu in the strongest possible term ask this committee to hold this. staff and the city attorney's office and the system that have been working hard are saying that procedurally you can't do it. the people in the city and county have said this otherwise that it requires 3 fourths vote to pass these items that the people of san francisco compel you to analyze this and scrutinize this and that's why they ask for a three fourths

vote. don't ask them. get a fair deal for san francisco, get a fair deal for the taxpayers and bring kaiser to the table. thank you. >> thank you. next speaker, please. >> bob, chairman of the puc and representative of local 21. i wack tfor a second and tell you that all of us within the puc and various labor unions are impressed with the work that the hhf staff have done over the last few years ascribed yes, -- described earlier to you. they have come with the interest of the city and with representative of the mayor's

office, and unions and hr to form this citywide committee to take a look at this. now we have moved to the area of accountability and transparency. we have all realized that more than a half a billion dollars on expenditure, this is really a subject area that needs more attention than some of the rest of us have been giving it and there is a way to support hhf going forward. it's not like pension or retiree health that we saw with a couple of ballot measures with the hope of the possibility of no extraordinary events that they will long into future solve pension problems. the health care problems is very different. it's going to require us in this change of environment to continue to monitor the work on health care to try to come up on strategies

on a continuing basis. there is not a one time fix on health care. as lisa mentioned earlier there is these units that open collective bargaining agreements for pricing in those contracts because we all now realize there are unintended consequences that can result to what we agree on in terms of health care. there is an intelligent strategy that we have to take. in the middle of these group discussions that we've been having at city hall in comes this story about kaiser and the rate increase and with hhf as leadership and all the unions in that

committee have joined forces and stepped forward and went before the hhf and went to them and asked them to reject the increase. hhf has done a turn around and for all the reasons that they have cited this morning that you accept it instead of reject it. when most of us are in the rejection mode that having felt the more information we receive, more felt more strongly that this was a give away and something that really shouldn't be accepted by either hhf or board of supervisors. i was happy when the kaiser representative were called to the podium. unfortunately i don't think they were asked the right questions. it seems to me that hhf is satisfied going forward and they have a plan in play. >> what would have been those

correct questions? >> i think the question to kaiser is what have they learned from this and what can they do? >> what are those correct questions? >> what have they learned from all that has transpired from the last couple of months and what are they willing to do differently going forward. are they willing to put the new rate increase intoes escrow and allow us to continue the discussions in terms of what we might do to improve the health of all the members. >> anything else you would have asked them? >> i think what was the reluctance to share the information that would explain the rate increase to us in greater detail, detail enough for us to understand what kind of value are we getting for our health care dollars from them. i would appreciate if you can call them to ask if there is anything they can do differently after all we have gone through in the last couple

of months. thank you. >> thank you, next speaker. good afternoon. i would like to address some of the comments made in the previous presentation by the city and by kaiser. i want to point out that some of what the city has been saying is that they are concerned about loss of service for our kaiser members. well, i heard kaiser up here say that their goal was to not have any break in service and that the real question is what are the actual rates are going to be. that's what we are saying. the rates should not increase to $15 million. that's what we want to happen. we want kaiser to come to their senses and understand that they can't just

have a blank check from san francisco. first they have to give us information but second of all this is unconscionable. i also want to point out that the person that talked about with the charter amendment says that you have to continue to provide health care, well, that goes to what kaiser just said that they would continue to provide health care. then the other concern i have is it sounds like that you have to vote yes. well, what's the point in having to vote yes. what's the point of this whole process if the supervisors have to vote yes. this is a democratic process. you can say no. that's what we are asking you to do is to say no. this is completely unjustified. another issue brought up, let's not do

it now, let's do it later. i don't think it's a difference. it's the same process with the same time lines and the same process that's going to come up. you need to take a stand now. >> hi, i'm a retired city employee. judy. the speaker brought up that we can continue kaiser and what i heard them say is that we would make some arrangements if that happened. i also heard other people say that they factor, the law will go into plan one if you don't pass this. you have no option to put the whole group into plan 1 whether they want to be in kaiser or otherwise. so, i think you have a choice between passing this through and dealing with the problem later or having everyone go into plan

one. the labor unions have other options too they are not bringing up. they can do a caesar chavez no grapes boycott, kaiser end up in one blue shield and why a boycott makes their point very clear and bring kaiser to the table with that sort of power play. i don't know much about all of this, but that's all i have been able to gather from the speakers. >> thank you. any other members of the public who wish to comment on this item no. 7? >> public comment is closed. >> do you have any questions? do you want to comment? i know there has been a lot said. i want to give you the chance to take the mic again. >> thank you, i really appreciate all the voices here and i think the frustration and

i think anger with kaiser is very well voiced. i think that medical needs of our membership in kaiser take precedence however and i think that the decision to potentially move away from kaiser can be made in 2015, made in a way much more responsible to the people that are receiving care by kaiser now. in 2015 if a plan is not resolved, we can close enrollment to kaiser for future enrollment or to allow the choice to bring cost-effective alternatives that members can opt into if they choose. i think that's a more prudent and responsible approach to this

problem. >> thank you. just a question for you. and i agree with all for showing up. the ones that did, i appreciate that. in terms of process, i think we can do a number of things. we have about a week with the full board here that we are in committee that we can hold the committee and continue it for a week. we have to buy this time schedule pass it out on the meeting by this month. if we do not do that, it would have to be sending it back and directing it to try to negotiate a better rate with kaiser and that would include kaiser because they would have to repackage. would the board of supervisors have to provide direction to do it with kaiser,

i want your direction on that implication? >> i think we would expect guidance from the board of supervisors if they are going to reject this rate package and what it is they would like to see as the revised rate package. that will not come until august, depending on the request. i think i just want to echo the sentiments of the health service system one more time to say that disrupting the care for 40,000 members is something that no one supports. it's one thing moving thirty thousand members from blue shield to city care. that has been done. those are the same physicians, just a different insurance company. this is

completely disrupting care. your lab values, your doctors, your primary care physicians, all of your care now has to be reestablished. it such a tremendous disruption that it would be ill advised to do that without a tremendous amount of planning. >> okay. and again, if there is direction to do a plan without kaiser to come back, because the board rejects those rates and perhaps the direction would be if we can't get a decreased rate to come back with a plan without kaiser. >> we have put blue shield on notice that that might be coming despite our objections and they are ready to prepare a rate for this board and plan a as well. >> so we would have one fully in insured plan as well as the blue shield plan. to be clear, though, because of the 2

percent cap and the reimbursement we receive and i think there is a difference if you want to call it subsidizing rates or not. the current blue shield rate would increase, though? >> the rate for blue shield have moving the kaiser people into blue shield would have to be reevaluated and reset. i'm not prepared to say if it would be higher or lower. it would have to be completely reset. the membership in kaiser is younger and healthier than the membership in blue shield. >> okay. at that point in time we talk about the competition of the service board, we are going to deal with one provider for the city. >> that's correct. in terms of the cost to the member, the mou's are still in existence which say is pegged off kaiser and the blue shield rate is higher. exactly how that would

work for 2014 is a real question. if we don't have kaiser, how do the mou's work. >> i obviously share and express more forcefully my expression and opinion as it relates to the kaiser health service board meeting and share all the sentiment about how this has gone forward. i do think what we don't have in front of us today which i think would be helpful if we come back to this committee, if you look back 10 years, if you start from the same point in time, when blue shield was increasing rates 15 percent and #16 percent a year and kaiser was 5 percent or less, to take a snapshot down the road is quite a bit ignorant without looking at the history and to say just one time we are not doing anyone a service here.

i'm not saying that i would like to see one rate staying relatively flat and the other rate going up by 5 percent. you look at that objectively on a piece of paper, you say why? that's the question that's being asked at the health service board and that's looking at what's been done. to look at at the historical perspective is completely misleading. i don't think we should be making decisions in terms of that perspective. my perspective and now this is the health service board with a lot of members, my gosh, someone with i consider almost a guru and someone i rely so much on her opinion with decades in

city hall t way to move forward is about transparency. i introduced that same resolution here at the board of supervisors. they will be in committee in a few months. i think we need to push the envelope in city hall. i would continue to lead on that. but i think, that down the road is to lead to lower health care rates and cost. that's the shared goal across everyone's perspective. we join on that as a city employee and employer and members. i understand we may have a difference of opinion today, but from my perspective taking a knee jerk 1 month rejection of rates after a 60 plus year relationship, 10-20 lower rates

despite other health providers, i think it's the wrong decision without a doubt. i'm absolutely convinced of that. to me it's a long-term process. you don't just shift providers. it's doctors, it's seniors, young people, families, everything. to change doctors is so disruptive. you can't plan that over night. i imagine you don't come up with an another kaiser in 1 month. it doesn't happen and it doesn't exist. colleagues, open for comments. i want to hear the final thoughts right now. that is my perspective. i share all the sentiments from this perspective. the way to handle is in a different approach. we need to be responsible for taking care of the big picture as it relates to all of our members. to me the emphasis is

on the members and not disrupting that at the same time driving the long-term lower cost. we are going to vote on the full board next week. this is about driving the liabilities down. i look forward joining on that and doing that together. >> supervisor mar? >> i wanted to appreciate supervisor farrell's expression of frustration of this process and expressing the long-term view that was brought up. i want to thank catherine dodd and the health service system for all the work to make sure that we have the best plan for our city. i want to say too that i'm a lifelong kaiser member and feel that despite the thrive marketing and other stuff they have kept me healthy

and my family as well. i don't treat lightly the 40,000 members with this decision. what i'm still frustrated about is questions from health work commissioners and scott and many others and not adequate answers or transparent answers from kaiser. i want kaiser to return to us to fully support their 2014 premium rate request. i want to see it based on union members utilization by full data. i do feel that kaiser made a representation that they wouldn't dump people off the roll and they would work something out. while it may involve some costing

issues. the threat of putting people's lives in jeopardy is not as much as i was concerned with earlier. as kaiser says there is time. my hope is by continuing this item, we buy ourselves more time with kaiser to give us that information so we are confident to make the best choice. i want to thank everyone for coming out and acknowledge the work of the health service board and the staff for their work. i don't want to jeopardize people's lives. i'm appreciate iv of the comments from everyone here. i recommend we move this item to the call of the chair. >> although kaiser said they would continue coverage, we would not be able to pay them. the city would not be allowed

to contribute the amount to kaiser until we had a contract with them. so it would be a very tenuous agreement at best. >> i did want to add then, i'm fully supportive of supervisor farrell and other folks that require transparency that reach at the state level in a draft of 2015. i feel we have to make a strong stand today and that's why i'm moving to continue this item. >> one comment was around we can just continue with kaiser. i want to be very clear on a few perspectives. maybe from our controllers office,